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Edwin F. Hirsch, M.D.
JAMA. 1954;155(9):837-838. doi:10.1001/jama.1954.73690270008010.
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An obese Negro, aged 46, first entered St. Luke's Hospital in August, 1950, because of the sudden onset of partial blindness. At that time papilledema, left cardiac enlargement, and hepatomegaly were noted. With medical management, including dietary restriction, he improved subjectively and lost 20 lb. (9.1 kg.) in weight. He was readmitted on Dec. 18, 1951, at which time he gave a history of excessive use of alcohol and heavy smoking. During the week prior to this admission he experienced sudden attacks of dyspnea, cardiac palpitation, epistaxis, diarrhea, and nocturia.

Physical Examination—  When he was admitted to the hospital, his blood pressure was 200/150 mm. Hg. His pulse was 114, and his respiratory rate was 18 per minute. Funduscopic examination of the eyegrounds disclosed exudative retinopathy. His breath had a uremic odor. His heart was enlarged to the left, and moist rales were heard in the lungs, especially on


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